Uterine rupture

Question 1

What are risk factors for uterine rupture?

Answer 1

• Previous C-section
• Obstructed labour in multiparous - esp. if oxytocin is used
• Previous cervical/uterine surgery
• High forceps delivery
• Internal version
• Breech extraction

Question 2

When does uterine rupture normally occur?

Answer 2

Labour or 3rd trimester

Question 3

What are symptoms of uterine rupture?

Answer 3

• Pain - can be mild or severe
• PV bleeding - variable
• Cessation of contractions

Question 4

What are signs of uterine rupture?

Answer 4

• Unexplained tachycardia
• Sudden maternal shock
• Cessation of contractions
• Disappearance of the presenting part from the pelvis
• Foetal distress

Question 5

What features may suggest uterine rupture post-partum?

Answer 5

• Continuous PPH despite well-contracted uterus
• Continuous PPH after vaginal repair
• Shocked patient

Question 6

How would you manage suspected uterine rupture in labour?

Answer 6

• ABCDE - O2, IV fluids, Crossmatch 6 units and correct shock
• Category 1 C-section + uterine exploration
  
  • May need Hysterectomy if damage severe
• Post-operative antibiotics - metranidazole + cefuroxime